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Randomized Controlled Trial
. 2017 Aug;31(8):967-974.
doi: 10.1177/0269881117711712. Epub 2017 Jun 21.

Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy

Mark T Wagner  1 , Michael C Mithoefer  2 , Ann T Mithoefer  2 , Rebecca K MacAulay  3 , Lisa Jerome  4 , Berra Yazar-Klosinski  5 , Rick Doblin  5
Affiliations
Randomized Controlled Trial

Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy

Mark T Wagner et al. J Psychopharmacol. 2017 Aug.

Abstract

A growing body of research suggests that traumatic events lead to persisting personality change characterized by increased neuroticism. Relevantly, enduring improvements in Post-Traumatic Stress Disorder (PTSD) symptoms have been found in response to 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. There is evidence that lasting changes in the personality feature of "openness" occur in response to hallucinogens, and that this may potentially act as a therapeutic mechanism of change. The present study investigated whether heightened Openness and decreased Neuroticism served as a mechanism of change within a randomized trial of MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD. The Clinician-Administered PTSD Scale (CAPS) Global Scores and NEO PI-R Personality Inventory (NEO) Openness and Neuroticism Scales served as outcome measures. Results indicated that changes in Openness but not Neuroticism played a moderating role in the relationship between reduced PTSD symptoms and MDMA treatment. Following MDMA-assisted psychotherapy, increased Openness and decreased Neuroticism when comparing baseline personality traits with long-term follow-up traits also were found. These preliminary findings suggest that the effect of MDMA-assisted psychotherapy extends beyond specific PTSD symptomatology and fundamentally alters personality structure, resulting in long-term persisting personality change. Results are discussed in terms of possible mechanisms of psychotherapeutic change.

Keywords: MDMA; NEO personality; openness; pharmacotherapy; posttraumatic stress disorder (PTSD); psychotherapy; treatment outcome.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Mark Wagner received compensation from the sponsor for acting as an independent rater on this study. Rebecca MacAulay has no conflict of interest to declare. Mark Wagner, Michael Mithoefer, and Rebecca MacAulay wrote the manuscript and conducted the analyses for this manuscript. The study sponsor played a role in the study design (the investigators performed all data collection). Three authors, Berra Yazar-Klosinski, Lisa Jerome, and Rick Doblin, are employed by the sponsor (Doblin, Yazar-Klosinski) or a wholly owned subsidiary of the sponsor (Jerome). Michael Mithoefer is a medical monitor for other studies of MDMA-assisted psychotherapy that are currently being conducted by the sponsor. He and Ann Mithoefer both received payment from the sponsor for conducting this research, while developing a treatment manual, investigator training program, and the design of protocols for additional studies planned by the sponsor.

Figures

Figure 1.
Figure 1.
Placebo vs. MDMA-treatment group means and standard errors for Clinician-Administered PTSD Scale (CAPS) Global Scores at baseline and 2 months. Change in Openness served as a covariate. Results represent the main effect of PTSD symptom reduction and the moderating effect of increased openness on therapy outcomes; all p values < .05.
Figure 2.
Figure 2.
Placebo vs. MDMA-treatment group means and standard errors for Clinician-Administered PTSD Scale (CAPS) Global Scores at baseline and 2 months. Change in Neuroticism served as a covariate. Results represent the main effect of group and the effect of decreased Neuroticism on therapy outcomes; all p values < .05.
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